Understanding self-injury and how to cope with emotional pain

Jun 1, 2017

Rate this article and enter to win Deliberately hurting oneself is among those human behaviors that seem baffling and counter-intuitive from the outside. A student who parties, gets depressed, and ends up cutting himself may fear that his peers just wouldn’t get it. A student who realizes that a friend pulls out her own hair may have no idea how to help. While most college students do not deliberately harm or injure themselves, it’s certainly happening on campuses, studies show.

“Self-injury tends to go through jags,” says Dr. Janis Whitlock, director of the Cornell Research Program on Self-Injury and Recovery at Cornell University, New York. “It’s not uncommon for someone to not injure for a year and then start again in college when they get triggered by a variety of stressors—everything from academic to romantic problems.” Understanding self-injury can help clue us in to the complexities of our own and others’ experience, and lead us to healthy ways to handle the stresses of school, however they manifest.

What is self-injury?

When people intentionally cause harm, pain, or damage to their own body, without the intent to die, it’s called non-suicidal self-injury (or self-harm). We tend to think of self-injury as cutting. In reality, it can be any type of behavior that intentionally causes tissue damage to the body, so it could involve burning, pulling out hair, or some acts of externalized aggression, such as punching walls. Self-injury may happen under the influence of drugs or alcohol (though using alcohol or drugs is not itself considered self-injury). Self-injury is different from suicidal self-harm, which is motivated by the intent to die and includes suicidal thinking. That said, people who self-injure are more likely than others to consider suicide (see: What raises the risk for self-injury?).

Self-injury is not necessarily used as a way to get attention from others. However, some people may self-injure because they haven’t yet learned how to ask for what they need in healthier ways. If someone needs attention, take it seriously.

Self-injury may co-occur with other issues, such as depression or anxiety, but it is not itself a disorder, diagnosis, or disease. Self-injury is a symptom.

Eating disorders, such as anorexia or bulimia nervosa, are different from self-injury, though people with eating disorders are at higher risk of self-injury compared to the general population, according to a 2015 meta-analysis by the Cornell Research Program on Self-Injury and Recovery.

Tattoos and piercings are not considered self-injury, unless someone is seeking out pain as a substitute for healthier ways to handle distress.

Heavy drinking or drug abuse is not technically a form of self-injury, though the behaviors are often related. A 2011 study in the Journal of American College Health found that almost one in five students who self-injured did so when under the influence of alcohol or other substances.

Self-injury is not the same as BDSM, erotic practices that involve submission and dominance, which may include consensual behaviors that cause physical pain. Self-injury is about seeking emotional release, while consensual BDSM practices are about sexual pleasure.

Self-injury may be a means by which some people feel more in control of how and when they experience pain.

Why do some people self-injure?

Self-injury can happen as a result of not being able to cope with certain stressors or emotions. “The behavior is seen a lot in college because the pressures during this timeframe—like grades, relationships, and jobs—increase,” says Dr. Retta Evans, associate professor of Community Health and Human Services at the University of Alabama at Birmingham.

Self-injury is more common in young adults who are also experiencing depression or anxiety, sexual abuse or trauma, eating disorders, or substance abuse. People who are LGBTQ are also at relatively high risk, perhaps because of the stress of social judgment. “Self-injury was a way to release inner pain that I didn’t know how to talk about,” says a third-year undergraduate at St. Clair College, Ontario.

People self-injure for a variety of reasons. Sometimes those reasons evolve over time. In our survey, many students referred to self-injury as a temporary behavior that they had managed to move past. “When I was in foster care I began to self-injure. I had recently been removed from a very dangerous situation and was dealing with what I had survived. I stopped harming myself when I was ready; I meditated a lot and worked through my issues,” said a fourth-year undergraduate at Portland State University, Oregon.

These are among the most common reasons for self-injuring:

1 To experience emotions differently

“I have severe anxiety attacks. Self-injury is a form of manifesting the emotional pain into physical pain. By doing this, I tell myself my pain is real.”—Second-year undergraduate, Portland State University, Oregon

2 To “take away” or escape from unwanted feelings or thoughts

“Self-injury to me meant an escape from emotional pain that I did not understand and did not want my family to see. It happened because I did not want to be seen as weak in my family’s eyes; I was supposed to be a role model.”—Fourth-year undergraduate, Dominican University, California

3 To bring recognition to their problems

“For me, it was a cry for attention. I was not getting the help I needed and had no real coping mechanisms.”—First-year undergraduate, East Tennessee State University

4 To avoid taking anger out on someone else

“I got so angry that I hurt myself because I couldn’t hurt the other person. I am a nice person, but when people do mean things toward me, I hurt myself instead. It’s the only way I can vent.”—Fourth-year graduate student, Berea College, Kentucky

5 To punish yourself or help you deal with a failure

“For me, self-injury was my way of punishing myself for who I was. I hated myself for things I did and the way I was. I hated who I was and thought I didn’t deserve happiness.”—Fourth-year undergraduate, California State University, Stanislaus

6 To continue the habit

“Self-injury was a form of punishing myself for perceived ‘stupidity’ when it began. But it’s currently a compulsion when I experience severe frustration or stress.”—Second-year graduate student, University of Rhode Island

Most people who self-injure start as teens—but self-injury is not a problem that goes away when they graduate high school. It can continue into college, restart when pressure builds, or begin later, experts say. “It’s very episodic, for a lot a people,” says Dr. Janis Whitlock, director of the Cornell Research Program on Self-Injury and Recovery at Cornell University, New York.

People don’t talk much about self-injuring, so it’s hard to know how commonly it happens. In a 2011 study, 15 percent of college students said they had self-injured at some point, and 7 percent had in the past year (Journal of American College Health), though estimates vary. In surveys, more women tend to report self-injury than men. On campuses, however, women and men may self-injure at similar rates. Most people who self-injure don’t seek support, research shows.

Most people who self-injure start in their early to mid-teens, according to the Cornell Research Program on Self-Injury and Recovery.

However, two studies found that close to 40 percent of participants who self-injured first did so at age 17 or later (Journal of Mental Health Counseling, 2008).

Most self-injurers (80 percent) stop within five years, research shows.

2 Depression and anxiety

In a 2009 study, participants with depression, anxiety, and perfectionist personality traits were significantly more vulnerable to self-injury, according to Suicide and Life-Threatening Behavior.

People who self-injure are more likely than others to consider or attempt suicide, research suggests. This may be because “people who have practice hurting their bodies may find it easier to hurt themselves lethally,” researchers say (Cornell Research Program on Self-Injury and Recovery website).

3 Child abuse and trauma

Adolescents who had been abused as children were significantly more likely to self-injure than their peers who had not been abused—especially if they had been abused by more than one individual, a 2015 study in the journal PLOS One found.

Even exposure to childhood abuse—for example, witnessing a sibling being abused—increases the later risk of self-harm, the researchers found.

4 Eating disorders

A large cohort of people who self-injure—54–61 percent—also have some form of eating disorder, such as anorexia or bulimia, according to a 2007 meta-analysis in Suicide and Life-Threatening Behavior.

Bulimia is more likely than other eating disorders to co-occur with self-injury, according to the Journal of Adolescent Health (2011).

Women with eating disorders are more likely to also self-injure than men with eating disorders, according to the same study.

5 Substance abuse

Drug use and frequent heavy drinking are associated with higher rates of self-injury, according to a 2010 study of almost 6,000 students in the Journal of Addictive Behaviors.

The researchers also found that self-injurers who used drugs were more depressed (another risk factor for self-injury) than those who didn’t use drugs.

6 Minority sexual or gender identity

Lesbian and gay adolescents are over twice as likely to self-injure as their heterosexual peers, according to a 2011 study in the Journal of American College Health.

People who identify as bisexual have the highest rates of self-injury. The same study found that bisexual adolescents were over three times as likely to self-injure as their heterosexual peers.

The higher rates of self-injury among the LGB community may be due to societal judgment about their identity, the stress of coming out, and the lack of belonging (especially among those who identify as bisexual), the researchers speculated.

Self-injury is relatively common among trans youths, especially those with higher levels of transphobia (conflict about their own identity) and interpersonal tensions, according to the Journal of Sexual Medicine (2016).

Research is currently mixed on this issue. Girls and women seem to self-injure more commonly than boys and men do. But some studies suggest that during young adulthood, men and women may self-injure at similar rates. For example, the 2011 study of college students found that women were more likely than men to report that they had ever self-injured, but women and men were equally likely to say they had self-injured within the past year (Journal of American College Health). (The student comments in this article come from men and women.)

Researchers have two main theories that may help explain the perceived gender differences in self-injury:

Women are more likely to speak up about self-injury; perhaps societal gender stereotypes make it easier for women than men to talk about emotional health issues.

“In some ways, men are better at hiding it than women [perhaps due to traditional gender roles]. If we see wounds on a guy’s knuckles we [might] assume he’s been working on a car or in a fight,” says Dr. Whitlock. “To an outsider, it looks like they’re trying to cause someone else pain, but the underlying motivation is often to cause themselves pain. For women, the telltale cuts on arms or ankles might be more obvious.”

Student voices

“My self-injury involved punching walls and seeking out fights to vent anger and frustration. Usually under the influence of alcohol.”—Fifth-year undergraduate (male), University of New Brunswick

“For many years I cut my thighs. They are horribly scarred now. I chose my thighs because I was embarrassed and didn’t want it to be obvious. I did it to cope and calm down because it always cleared my head. I was in a dark place, but I hid it from my friends and family—just like the scars.” —Fourth-year undergraduate (female), University of New Brunswick

How to help yourself or a friend who self-injures

Usually, when people learn how to cope with their emotions and talk about how they feel, they experience less of an urge to hurt themselves. Simple techniques and skills can decrease the intensity of emotions and make them more manageable. “Finding a different outlet [for distress] was the key to my recovery,” says a second-year undergraduate at SAIT Polytechnic, Alberta. These three approaches can help you or a friend:

1 Reach out and talk

If you are self-injuring, reach out. Talk to a friend, mentor, RA, professor, member of your religious community, or member of your support group (in person or online). Ask for their support, and spend time with people who make you feel good.

If you’re concerned that someone else may be self-injuring, check in with them. “Let your friend know you care,” says Dr. Lance Swenson, associate professor in psychology at Suffolk University, Massachusetts. “Remind your friend you are there to listen. Tell them you can help them get help. Most people who self-injure are not consciously aware of why they are [doing it], at least not in the moment.” Seek out support for yourself too, so that you’re in a strong position to be there for your friend.

“Let your friend know you care,” says Dr. Lance Swenson, an associate professor in the psychology department at Suffolk University, Massachusetts. “Remind your friend you are there to listen. Tell them you can help them get help. Most people who self-injure are not consciously aware of why they are [doing it], at least not in the moment. They shouldn’t feel like they have to face it alone.”

That said, it’s not on you to solve this. “The roots of self-injurious behavior are likely very complicated. No matter how much you care about a friend, and how hard you try to help, they may continue this behavior despite your best efforts to help them,” says Dr. Davis Smith, a physician at the University of Connecticut.

How to talk to a friend you are concerned about:

Ask straightforward, direct questions in a calm manner, such as, “Are you thinking about hurting yourself?”

Actively listen—focus on what they’re saying—then offer support.

Take your friend seriously. If your friend mentions any thoughts about suicide, especially a plan or method, call 911 or speak to a dean or campus counselor.

Encourage your friend to talk to a trusted mentor, RA, professor, coach, or member of their religious community; be there for them, but do not take on the full burden yourself.

Encourage your friend to consider seeking help from a licensed mental health professional (for example, a psychologist, social worker, or counselor—ask at your campus health center or counseling center).

2 Test coping strategies and figure out what works

If you’re concerned about a friend, you may be able to help them explore these techniques. If you’re self-injuring, test these strategies and take note of what helps. “Distress tolerance skills” can be used in place of self-injury. See Get help or find out more (below) for more info.

For example, listen to your favorite upbeat song, or watch a funny YouTube video. Look in the mirror and smile—watch as your expression changes.

2 Exercise hard and fast:

Do 25 jumping jacks, go for a jog, or dance around the room. Research shows that cardio exercise can reduce your stress and improve your mood. Regular physical activity can be protective.

3 Use your five senses:

This helps you connect with what is going on around you and anchor yourself in the present moment. For example, sink your heels into the floor or ground and focus on how it feels beneath your body. Hold something soft or fuzzy. Squeeze a stress ball. Place a cool, wet washcloth on your face. Light a scented candle and breathe in deeply. Cook and/or eat your favorite food and really allow yourself to enjoy the flavor. Go for a walk or drive and take in the sights and smells. Take ice from the freezer and hold it tightly in your hand. Get into warm water (take a shower or bath).

4 Take slow, deep breaths:

Imagine you are blowing up a balloon. When you inhale deeply, your lower belly should expand. Count to three on each inhale and each exhale.

5 Think about your emotions:

Face them instead of pushing them away. Labeling an emotion (e.g., “My heart is racing and I’m feeling anxious”) can often help you figure out why you’re feeling that way (e.g., “I have a big exam coming up next week and I’m anxious about studying for it”). Write down how you’re feeling in a notebook or journal.

6 Focus on your heart:

Put your hand on your heart so you can feel your heartbeat and count the beats per minute. Try to slow down your heart rate by taking slow, deep breaths.

7 Actively cherish what you have:

Look at pictures on your phone or computer that make you smile. Make a list of all of the things you are grateful for or happy about in your life.

8 Actively cherish who you are:

Make a list of your accomplishments—e.g., “I do pretty well in school,” “I am a caring friend,” “I take excellent care of my dog.”

9 Sink into something else:

Read a book, story, or article. Listen to your favorite music, play an instrument, or sing (even if you have no musical talent!). Engage in your favorite hobby or master a skill, such as gardening, cooking, baking, playing a video game, knitting, painting, or drawing.

10 Prioritize sleep:

Get up as close to the same time every day as possible; this will help you go to bed at a more regular time too. Your bed is for sleeping only (no electronics or social networking). Relish it.

3 Consider seeking professional support

Checking in with a counselor can relieve some of the pressure and help you find strategies and resources you wouldn’t otherwise know about—whether it’s you who’s self-injuring or your friend. Your student health center or counseling center may be able to help directly or refer you to an expert medical provider. Certain therapeutic techniques—such as cognitive behavioral therapy (CBT) or dialectical behavioral therapy—are designed to build healthy coping skills directly. If you ever feel suicidal, call 911, go to the nearest emergency room, or call the National Suicide Prevention Lifeline at 1-800-273-8255.

“I did not want to feel hopeless and alone anymore,” says a first-year undergraduate at California State University, Channel Islands. “I decided go to counseling to cope with my self-injuring tendencies. Every session I attended helped me gain the confidence to be myself, and most importantly, to love myself. Don’t be afraid to seek help.”

Find out here

Fourth-year undergraduate, Portland State University, Oregon

“Resisting the urge to self-injure as a coping mechanism can be a constant struggle for many. Calm Harm is designed to manage that urge and direct users to safer and more effective ways of managing stressors.”

USEFUL? Based on dialectical behavioral therapy (worth looking into on its own), the app provides options for what you can do instead of hurting yourself when you’re feeling negative emotions. While clicking through menus is tedious at times, the techniques were actually helpful (which was my main concern).

FUN?Helpful and appropriate, definitely. But something like this isn’t really ever going to be “fun”—the question is whether it works.

EFFECTIVE? No app will “solve” the problem outright, but this has real potential to help. Calm Harm does what it sets out to do: provide alternatives to self-harm in the short term so that more definitive treatment can be sought/have time to work.

Stephanie Jarvi, MA is completing her PhD in clinical psychology at Suffolk University in Boston. She is writing her dissertation on non- suicidal self-injury and identity, for which she received a funding award from the National Institute of Mental Health. Stephanie has published articles on self-injury in psychological journals and has helped many teenagers successfully learn to cope with their self-injury.